PCSK9 Inhibitor for Intracranial Atherosclerosis Related Acute Ischemic Stroke

Acute ischemic stroke (AIS) remains one of the leading causes of death and disability worldwide. Although intravenous thrombolysis and endovascular therapies have significantly improved reperfusion success rates, three critical challenges persist in clinical practice that determine prognosis: First, only a limited proportion of patients can actually receive reperfusion therapy within the therapeutic time window; Second, even with successful reperfusion, secondary injuries such as microcirculatory perfusion failure, inflammatory cascades, and thrombus reformation may still occur. Third, acute phase fluctuations, particularly early neurological deterioration and the risk of early recurrence, remain prominent, directly limiting improvements in functional outcomes. 3 Intracranial atherosclerotic stenosis (ICAS) accounts for up to 50% of ischemic stroke etiologies in China. Its pathological chain-"plaque instability-thrombosis-microcirculatory impairment"-permeates both the acute and subacute phases, closely correlating with early recurrence and poor outcomes.Proprotein convertase subtilisin/kexin type 9 (PCSK9) classically promotes the degradation of low-density lipoprotein cholesterol (LDL-C) receptors and elevates LDL-C levels, thereby driving atherosclerosis progression. More importantly, growing basic and translational research suggests that PCSK9 may not only function as a "lipid metabolism protein" but also participate in processes such as endothelial activation, inflammatory cascades, platelet reactivity, and microcirculatory dysfunction. This positions it as a potential hub connecting the "plaque-thrombus-inflammation" axis. Consequently, PCSK9 inhibitors may offer additional neurovascular protective benefits beyond lipid-lowering effects during the acute phase of acute ischemic stroke (AIS).Existing basic and clinical evidence suggests that PCSK9 inhibitors may exert a combined intervention effect on key pathological processes driving atherosclerosis during the acute phase of AIS through a dual mechanism involving both lipid-dependent and non-lipid-dependent pathways. Mechanistic studies reveal that PCSK9 inhibition simultaneously modulates inflammatory responses, endothelial activation, dysfunction, and thrombogenic tendencies. In ischemia-reperfusion models, it demonstrates neuroprotective signaling by mitigating brain injury and improving neurological function. Clinically, large randomized trials confirm its ability to rapidly enhance lipid-lowering effects beyond statins and reduce ischemic stroke risk. Further translational evidence in cerebrovascular disease indicates that in symptomatic ICAS populations, PCSK9 inhibitor plus statin-enhanced lipid-lowering therapy reduces plaque burden, alleviates stenosis, and increases plaque stability. In the acute phase of AIS, early addition of PCSK9 inhibitors correlates with reduced neurological deterioration within 7 days, decreased recurrence risk within 30 days, and improved functional outcomes at 90 days. Collectively, this evidence chain spanning mechanisms to clinical practice provides clear scientific rationale and clinical necessity for adding PCSK9 inhibitors to the treatment of ICAS-associated AIS.This study is a nationwide, prospective, multicenter, double-blind, randomized, placebo-controlled clinical trial. It will enroll 1,212 patients meeting inclusion and exclusion criteria. Patients will be randomly assigned to two groups using a randomized allocation method: (1) Experimental group: 450 mg of Recaticimab for Injection (3 vials) administered as a single subcutaneous injection. (2) Control group: Placebo of Recaticimab for Injection 450 mg (3 vials) administered as a single subcutaneous injection. Each group will include 606 patients. Both groups will receive standard guideline-recommended treatment in addition to the study drug. Long-term efficacy was assessed through patient visits and evaluations at 0 hours, 24 hours (±2 or ±12 hours), 7 days (±2 days) or at discharge, 90 days (±7 days), and 1 year.Primary outcome measures included: Analysis based on the intention-to-treat principle using an ANCOVA model for all randomized patients with baseline HRMRI and a modified Rankin Scale (mRS) score of 0-2 at 90 days. Secondary outcome measures included: (1) mRS score of 0-1 at 90 days (indicating good patient function); (2) Distribution of 90-day mRS scores; (3) Any stroke (including ischemic and hemorrhagic) within 90 days; (4) Ischemic stroke within 90 days; (5) Composite vascular events (including stroke, myocardial infarction, and vascular death) within 90 days; (6) 90-day European Quality of Life 5-Dimension 5-Level Scale (EQ-5D-5L) score; (7) 90-day Barthel Index (BI) score.Details are provided in the "Outcome Measures" section.The sample size is calculated based on the primary outcome and a total of 1212 participants are anticipated. An independent Data Safety Monitoring Board will oversee the overall conduct of the trial.

• Recaticimab plus standard therapy (Drug): Recaticimab (450 mg single dose, subcutaneous injection) combined with standard therapy recommended by the AHA/ASA Guidelines for Early Management of Acute Ischemic Stroke 2026 and the Chinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke 2023.
• Recaticimab's placebo in combination with standard therapy (Drug): The placebo and investigational ricaximab were identical in appearance, packaging, labeling, administration method, and dosing frequency, managed through a unified production and coding system. Standard treatment followed the recommendations outlined in the "AHA/ASA Guidelines for the Early Management of Acute Ischemic Stroke 2026" and the "Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2023."

Primary outcomes

• Proportion of participants with functional independence, defined as a modified Rankin Scale score of 0-2, at Day 90 [Day 90 (±7 days) after randomization]: The modified Rankin Scale (mRS) is a 7-category ordinal scale ranging from 0 (no symptoms) to 6 (death), with lower scores indicating better functional status. This outcome is the proportion of participants with an mRS score of 0-2, representing functional independence. Participants who die before the Day 90 assessment will be assigned an mRS score of 6. The assessment will be performed by trained assessors blinded to treatment allocation.

Secondary outcomes

• Proportion of participants with an excellent functional outcome, defined as an mRS score of 0-1, at Day 90 [Day 90 (±7 days) after randomization]: The mRS ranges from 0 (no symptoms) to 6 (death), with lower scores indicating better functional status. This outcome is the proportion of participants with an mRS score of 0-1, representing an excellent functional outcome. Participants who die before the assessment will be assigned an mRS score of 6.
• Distribution of modified Rankin Scale (mRS) scores at Day 90 [Day 90 (±7 days) after randomization]: The ordinal distribution of mRS scores across all seven categories will be assessed. The mRS ranges from 0 (no symptoms) to 6 (death), with lower scores indicating better functional status. The outcome will evaluate a shift toward better functional outcomes across the full mRS distribution.
• Incidence of any stroke through Day 90 [From randomization through Day 90]: Proportion of participants who experience an adjudicated stroke after randomization, including either ischemic stroke or hemorrhagic stroke. Suspected events will be reviewed by an independent Clinical Event Committee blinded to treatment allocation.
• Incidence of ischemic stroke through Day 90 [From randomization through Day 90]: Proportion of participants who experience an adjudicated ischemic stroke after randomization. Ischemic stroke is defined as a new focal neurological injury attributable to cerebral ischemia, supported by clinical findings and/or imaging evidence of acute cerebral infarction, and not explained by a nonischemic cause. Events will be adjudicated by an independent blinded Clinical Event Committee.
• Incidence of composite vascular events through Day 90 [From randomization through Day 90]: Proportion of participants who experience at least one component of the composite endpoint after randomization. The composite endpoint includes any stroke, myocardial infarction, or vascular death. Events will be adjudicated by an independent Clinical Event Committee blinded to treatment allocation.
• Barthel Index score at Day 90 [Day 90 (±7 days) after randomization]: Activities of daily living will be assessed using the Barthel Index. The total score ranges from 0 to 100, with higher scores indicating greater independence in activities of daily living and better functional status.
• Health-related quality of life assessed using the EQ-5D-5L at Day 90 [Day 90 (±7 days) after randomization]: Health-related quality of life will be assessed using the European Quality of Life 5-Dimension 5-Level instrument. The descriptive system assesses mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, with five levels of severity for each dimension. Overall self-rated health will also be assessed using the EQ visual analogue scale, ranging from 0 (worst imaginable health) to 100 (best imaginable health).
• National Institutes of Health Stroke Scale score at Day 7 or hospital discharge [Day 7 (±2 days) after randomization or at hospital discharge, whichever occurs first]: Neurological impairment will be assessed using the National Institutes of Health Stroke Scale (NIHSS). The NIHSS ranges from 0 to 42, with higher scores indicating greater neurological impairment.
• Change from baseline in NIHSS score at Day 7 or hospital discharge [From baseline to Day 7 (±2 days) after randomization or hospital discharge, whichever occurs first]: Change in NIHSS score will be calculated as the follow-up NIHSS score minus the baseline NIHSS score. The NIHSS ranges from 0 to 42, with higher scores indicating greater neurological impairment. A negative change indicates neurological improvement, whereas a positive change indicates neurological worsening.
• Proportion of participants achieving an LDL-C level below 1.4 mmol/L at Day 7 or hospital discharge [Day 7 (±2 days) after randomization or at hospital discharge, whichever occurs first]: Proportion of participants whose measured low-density lipoprotein cholesterol (LDL-C) concentration is below 1.4 mmol/L at the scheduled assessment.
• Proportion of participants achieving an LDL-C level below 1.8 mmol/L at Day 7 or hospital discharge [Day 7 (±2 days) after randomization or at hospital discharge, whichever occurs first]: Proportion of participants whose measured low-density lipoprotein cholesterol (LDL-C) concentration is below 1.8 mmol/L at the scheduled assessment.
• Change from baseline in LDL-C level at Day 7 or hospital discharge [From baseline to Day 7 (±2 days) after randomization or hospital discharge, whichever occurs first]: Change in LDL-C concentration will be calculated as the follow-up LDL-C value minus the baseline value and reported in mmol/L. A negative value indicates a reduction in LDL-C from baseline.

Other outcomes

• Change from baseline in NIHSS score at 24 hours [From baseline to 24 hours after randomization, with an allowable assessment window of -2 to +12 hours]: Change in NIHSS score will be calculated as the 24-hour NIHSS score minus the baseline NIHSS score. The NIHSS ranges from 0 to 42, with higher scores indicating greater neurological impairment. A negative change indicates neurological improvement.
• Cerebral infarct volume at Day 7 or hospital discharge [Day 7 (±2 days) after randomization or at hospital discharge, whichever occurs first]: Cerebral infarct volume will be quantified in milliliters using follow-up CT or MRI and assessed by a blinded core imaging laboratory. Lower infarct volumes indicate less extensive ischemic brain injury.
• Cerebral perfusion parameters at Day 7 or hospital discharge [Day 7 (±2 days) after randomization or at hospital discharge, whichever occurs first]: Prespecified quantitative cerebral perfusion parameters derived from CT perfusion or MR perfusion imaging will be assessed by a blinded core imaging laboratory.
• Serum interleukin-6 concentration at Day 7 or hospital discharge [Day 7 (±2 days) after randomization or at hospital discharge, whichever occurs first]: Serum interleukin-6 concentration will be measured as a marker of systemic inflammation. Higher concentrations indicate greater inflammatory activity. Testing will be performed according to the prespecified laboratory procedures.
• High-sensitivity C-reactive protein concentration at Day 7 or hospital discharge [Day 7 (±2 days) after randomization or at hospital discharge, whichever occurs first]: High-sensitivity C-reactive protein concentration will be measured as a marker of systemic inflammation. Higher concentrations indicate greater inflammatory activity.
• Incidence of any stroke through 1 year [From randomization through 1 year]: Proportion of participants who experience an adjudicated ischemic or hemorrhagic stroke after randomization. Events will be reviewed by an independent Clinical Event Committee blinded to treatment allocation.
• Incidence of ischemic stroke through 1 year [From randomization through 1 year]: Proportion of participants who experience an adjudicated ischemic stroke after randomization. Events will be reviewed by an independent Clinical Event Committee blinded to treatment allocation.
• Incidence of composite vascular events through 1 year [From randomization through 1 year]: Proportion of participants who experience at least one component of the composite endpoint, defined as any stroke, myocardial infarction, or vascular death. Events will be adjudicated by an independent blinded Clinical Event Committee.
• Health-related quality of life assessed using the EQ-5D-5L at 1 year [At 1 year after randomization]: Health-related quality of life will be assessed using the EQ-5D-5L descriptive system, covering mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Overall self-rated health will also be assessed using the EQ visual analogue scale ranging from 0 to 100, with higher scores indicating better perceived health.
• Barthel Index score at 1 year [At 1 year after randomization]: Activities of daily living will be assessed using the Barthel Index. The total score ranges from 0 to 100, with higher scores indicating greater independence and better functional status.
• Incidence of moderate-to-severe symptomatic intracranial hemorrhage within 72 hours [From randomization through 72 hours after randomization]: Proportion of participants with symptomatic intracranial hemorrhage according to the modified Heidelberg criteria. The event must include imaging-confirmed intracranial hemorrhage, an increase of at least 4 points in the total NIHSS score compared with baseline or a previously recorded NIHSS score, and neurological deterioration that cannot be explained by a cause other than the intracranial hemorrhage. Qualifying hemorrhage types include parenchymal hematoma type 1 or 2, remote intracranial hemorrhage, subarachnoid hemorrhage, intraventricular hemorrhage, or subdural hemorrhage.
• All-cause mortality through Day 90 [From randomization through Day 90]: Proportion of participants who die from any cause after randomization and through Day 90. Death will be recorded as an mRS score of 6.
• Incidence of adverse events through Day 90 [From administration of the study intervention through Day 90 after randomization]: Proportion of participants who experience at least one adverse event after administration of the study intervention. Adverse events will be recorded with respect to onset, duration, severity, relationship to the study intervention, action taken, and outcome, and will be coded using the Medical Dictionary for Regulatory Activities.
• Incidence of serious adverse events through Day 90 [From administration of the study intervention through Day 90 after randomization]: Proportion of participants who experience at least one serious adverse event. A serious adverse event is an event that results in death, is life-threatening, requires inpatient hospitalization or prolongation of hospitalization, results in persistent or significant disability, causes a congenital anomaly or birth defect, or is considered an important medical event requiring intervention to prevent a serious outcome.

Sex: All, ages: 30 Years to 80 Years

Inclusion Criteria

1. Age 30 to 80 years, inclusive.
2. Acute ischemic stroke with symptom onset within 72 hours before screening, diagnosed on the basis of neurological deficits and CT or MRI findings.
3. National Institutes of Health Stroke Scale (NIHSS) score of 4 to 25 at hospital admission.
4. CTA, DSA, or MRA evidence that the culprit intracranial artery has atherosclerotic stenosis of 50% to 99%.

Exclusion Criteria

1. Intracranial arterial stenosis attributable to a nonatherosclerotic cause, such as arterial dissection, moyamoya disease, or systemic vasculitis.
2. Any definite source of cardioembolism, such as atrial fibrillation, a mechanical prosthetic heart valve, left ventricular thrombus, or patent foramen ovale.
3. Clinical and imaging findings suggesting that the index ischemic event is primarily attributable to cerebral small vessel disease.
4. Pre-stroke disability, defined as a modified Rankin Scale score of 2 or higher before the index ischemic event.
5. Extensive cerebral infarction on CT or MRI, such as an Alberta Stroke Program Early CT Score (ASPECTS) below 6 or an infarct volume of 70 mL or greater.
6. Previous stent implantation in the culprit vessel or planned stent implantation in the culprit vessel within 3 months after enrollment.
7. Any intracranial hemorrhage within 3 months before enrollment.
8. An intracranial tumor; or a cerebral aneurysm or arteriovenous malformation judged to require interventional treatment.
9. Severe active bleeding tendency or coagulation disorder.
10. Severe cardiac, hepatic, renal, or other major organ dysfunction.
11. Treatment with a PCSK9 monoclonal antibody inhibitor within 1 month before enrollment or with a PCSK9-targeting small interfering RNA therapy within 6 months before enrollment.
12. A definite contraindication to statin therapy or a history of statin intolerance.
13. Pregnant or breastfeeding, or planning to become pregnant during the study.
14. Current participation in another clinical trial.

• Results publication: Zhao W, Li S, Li C, Wu C, Wang J, Xing L, Wan Y, Qin J, Xu Y, Wang R, Wen C, Wang A, Liu L, Wang J, Song H, Feng W, Ma Q, Ji X; TREND Investigators. Effects of Tirofiban on Neurological Deterioration in Patients With Acute Ischemic Stroke: A Randomized Clinical Trial. JAMA Neurol. 2024 Jun 1;81(6):594-602. doi: 10.1001/jamaneurol.2024.0868. PMID 38648030
• Results publication: Tao C, Liu T, Cui T, Liu J, Li Z, Ren Y, Zhao X, Xie F, Li J, Wang H, Huang L, Li J, Wen J, Zeng J, Zhu J, Li Z, Li D, Hu X, Huang B, Wang J, Zhang C, Ye B, Hou Y, Gan Y, Sun H, Guan F, Shao Y, Liu Z, Ou Z, Fan S, Wang Y, Zhai H, Ni C, Wang H, Zhang C, Zhao Y, Wang G, Zhu Y, Li R, Sun J, Hu H, Cui J, Wang L, Zhang C, Song J, Jing X, Wang A, Wang J, Xu P, Qureshi AI, Nguyen TN, Nogueira RG, Saver JL, Hu W; ASSET-IT Investigators. Early Tirofiban Infusion after Intravenous Thrombolysis for Stroke. N Engl J Med. 2025 Sep 25;393(12):1191-1201. doi: 10.1056/NEJMoa2503678. Epub 2025 Jul 4. PMID 40616232
• Results publication: Wang C, Gu H, Huo X, Yuan B, Li S, Xu J, Jiang Y, Jing J, Yao X, Li Z, Long F, Ma Z, Zhuang X, Xu L, Jin Y, Huang W, Zhang Y, Wen J, Wang A, Pan Y, Ye W, Yu W, Cheng A, Wang M, Dong Q, Xu A, Wang N, Yang Y, Meng X, Liu L, Zhao X, Li H, Miao Z, Li Z, Wang Y; TASTE-2 investigators. Edaravone dexborneol versus placebo on functional outcomes in patients with acute ischaemic stroke undergoing endovascular thrombectomy (TASTE-2): randomised controlled trial. BMJ. 2026 Jan 7;392:e086850. doi: 10.1136/bmj-2025-086850. PMID 41500725
• Results publication: Writing Committee for the PEARL Investigators; Yang X, He X, Xu Y, Pan D, Li K, Chen Y, Zhu Y, Pan Y, Yi T, Zhang M, Peng H, Huang W, Li D, Feng J, Chen J, Lu W, Liao B, Xie Y, Liao B, Yang L, Tang L, Han B, Liu Y, Lin P, Chen J, Liang Y, Li D, Weng G, Huang H, Li H, Li C, Peng Z, Li H, He B, Xue R, Bao M, Sun H, Hou H, Zhou H, Xiao Y, Li J, Zhang W, Chen X, Yan W, Pi Y, Deng Z, Wang J, Xie D, Liu M, Li H, Peng Q, Fang W, Lin X, Chen Z, Li H, Lin Y, Lin Q, Xiao S, Miao Z, Wang D, Nguyen TN, Nogueira RG, Liu Y, Tang Y; PEARL investigators. Intra-Arterial Alteplase After Successful Endovascular Reperfusion in Acute Stroke: The PEARL Randomized Clinical Trial. JAMA. 2025 Oct 13;334(19):1728-39. doi: 10.1001/jama.2025.16876. Online ahead of print. PMID 42262770
• Results publication: Kim J, Hong U, Yoon CW, Bae JW, Rha JH, Park HK. PCSK9 inhibitor in acute ischemic stroke patient receiving mechanical thrombectomy: early outcomes and safety. Front Neurol. 2024 May 16;15:1375609. doi: 10.3389/fneur.2024.1375609. eCollection 2024. PMID 38817546
• Results publication: Liu L, Chen W, Zhou H, Duan W, Li S, Huo X, Xu W, Huang L, Zheng H, Liu J, Liu H, Wei Y, Xu J, Wang Y; Chinese Stroke Association Stroke Council Guideline Writing Committee. Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of ischaemic cerebrovascular diseases. Stroke Vasc Neurol. 2020 Jun;5(2):159-176. doi: 10.1136/svn-2020-000378. Epub 2020 Jun 18. PMID 32561535
• Results publication: Prabhakaran S, Gonzalez NR, Zachrison KS, Adeoye O, Alexandrov AW, Ansari SA, Chapman S, Czap AL, Dumitrascu OM, Ishida K, Jadhav AP, Johnson B, Johnston KC, Khatri P, Kimberly WT, Lee VH, Leslie-Mazwi TM, Mac Grory B, Madsen TE, Menon B, Mistry EA, Park S, Parker S, Perez de la Ossa N, Reeves M, Saiz T, Scott PA, Schwartzberg D, Sheth SA, Sporns PB, Times S, Tjoumakaris S, Wolfe SQ, Yaghi S; Peer Review Committee. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2026 Aug;57(8):e316-e436. doi: 10.1161/STR.0000000000000513. Epub 2026 Jan 26. PMID 41582814
• Results publication: Sun Y, Lv Q, Guo Y, Wang Z, Huang R, Gao X, Han Y, Yao Z, Zheng M, Luo S, Li Y, Gu X, Zhang Y, Wang J, Hong L, Ma X, Su G, Sheng J, Lai C, Shen A, Wang M, Zhang W, Wu S, Zheng Z, Li J, Zhong T, Wang Y, He L, Du X, Ma CS. Recaticimab as Add-On Therapy to Statins for Nonfamilial Hypercholesterolemia: The Randomized, Phase 3 REMAIN-2 Trial. J Am Coll Cardiol. 2024 Nov 12;84(20):2037-2047. doi: 10.1016/j.jacc.2024.09.012. PMID 39505412
• Results publication: Xu M, Wang Z, Zhang Y, Liu Y, Huang R, Han X, Yao Z, Sun J, Tian F, Hu X, Ma L, Lai C, Zhang X, Sheng J, Han Q, Jin C, Luo L, Zhao R, Li L, Xu B, Yin D, Luo S, Ge X, Liu Z, Yang P, Huang Z, Li T, Feng W, Wu Y, Ling Z, Ma L, Lv C, Deng C, Wei W, Wang Y, Yan L, Ge J; REMAIN-1 Investigators. Recaticimab Monotherapy for Nonfamilial Hypercholesterolemia and Mixed Hyperlipemia: The Phase 3 REMAIN-1 Randomized Trial. J Am Coll Cardiol. 2024 Nov 12;84(20):2026-2036. doi: 10.1016/j.jacc.2024.07.035. Epub 2024 Oct 9. PMID 39387764
• Results publication: Liu J, Li Y, Tian W, Cao H, Li X, Cheng L, Ji X, Liu J. Effects of PCSK9 inhibitor evolocumab on preventing early neurological deterioration in acute ischemic stroke patients with or without large artery atherosclerosis: a subgroup analysis of a randomized trial. BMC Neurol. 2025 Oct 17;25(1):431. doi: 10.1186/s12883-025-04434-8. PMID 41107765
• Results publication: Wu L, Zhang B, Li C, Zhuang Z, Liu K, Chen H, Zhu S, Zhu J, Dai Z, Huang H, Jiang Y. PCSK9 inhibitors reduced early recurrent stroke in patients with symptomatic intracranial atherosclerotic stenosis. J Neurol Neurosurg Psychiatry. 2024 May 14;95(6):529-535. doi: 10.1136/jnnp-2023-332392. PMID 38212060
• Results publication: Tian W, Cao H, Li X, Gong X, Yu X, Li D, Xie J, Bai Y, Zhang D, Li X, Xu P, Liu J, Zhang B, Ji X, Dong H. Adjunctive PCSK9 Inhibitor Evolocumab in the Prevention of Early Neurological Deterioration in Non-cardiogenic Acute Ischemic Stroke: A Multicenter, Prospective, Randomized, Open-Label, Clinical Trial. CNS Drugs. 2025 Feb;39(2):197-208. doi: 10.1007/s40263-024-01145-5. Epub 2025 Jan 5. PMID 39755915
• Results publication: Zeng W, Zhou F, Zhao H, Wang Y, Chen J, Lu J, Zheng D, Kuang J, Yuan D, Zhou J, Shi C, Zhao X, Leng X, Yan B, Tan Z. Evaluation of Intensive Statins and Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors on Intracranial Artery Plaque Stability: A Prospective Single-Arm Study. J Am Heart Assoc. 2025 Jan 21;14(2):e035651. doi: 10.1161/JAHA.124.035651. Epub 2025 Jan 17. PMID 39818872
• Results publication: Hu X, Liu Y, Yuan W, Zhang Z, Li S, Cheng A, Yu Q, Guo H, Zou Y, Li M, Liu C, Xu Y, Xu W. Evolocumab Added to Statin Is Associated With Intracranial Atherosclerotic Plaque Regression Compared With Statin Alone. J Am Heart Assoc. 2025 Aug 19;14(16):e041251. doi: 10.1161/JAHA.124.041251. Epub 2025 Aug 18. PMID 40820974
• Results publication: Jukema JW, Zijlstra LE, Bhatt DL, Bittner VA, Diaz R, Drexel H, Goodman SG, Kim YU, Pordy R, Reiner Z, Roe MT, Tse HF, Montenegro Valdovinos PC, White HD, Zeiher AM, Szarek M, Schwartz GG, Steg PG; ODYSSEY OUTCOMES Investigators. Effect of Alirocumab on Stroke in ODYSSEY OUTCOMES. Circulation. 2019 Dec 17;140(25):2054-2062. doi: 10.1161/CIRCULATIONAHA.119.043826. Epub 2019 Nov 11. PMID 31707788
• Results publication: Sabatine MS, Giugliano RP, Keech AC, Honarpour N, Wiviott SD, Murphy SA, Kuder JF, Wang H, Liu T, Wasserman SM, Sever PS, Pedersen TR; FOURIER Steering Committee and Investigators. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med. 2017 May 4;376(18):1713-1722. doi: 10.1056/NEJMoa1615664. Epub 2017 Mar 17. PMID 28304224
• Results publication: Wang L, Wang Z, Shi J, Jiang Q, Wang H, Li X, Hao D. Inhibition of proprotein convertase subtilisin/kexin type 9 attenuates neuronal apoptosis following focal cerebral ischemia via apolipoprotein E receptor 2 downregulation in hyperlipidemic mice. Int J Mol Med. 2018 Oct;42(4):2098-2106. doi: 10.3892/ijmm.2018.3797. Epub 2018 Jul 31. PMID 30066942
• Results publication: Zheng Y, Zhu T, Li G, Xu L, Zhang Y. PCSK9 inhibitor protects against ischemic cerebral injury by attenuating inflammation via the GPNMB/CD44 pathway. Int Immunopharmacol. 2024 Jan 5;126:111195. doi: 10.1016/j.intimp.2023.111195. Epub 2023 Dec 4. PMID 38048667
• Results publication: Luo Y, Yuan L, Liu Z, Dong W, Huang L, Liao A, Xie Y, Liu R, Lan W, Cai Y, Zhu W. Inhibition of PCSK9 Protects against Cerebral Ischemia-Reperfusion Injury via Attenuating Microcirculatory Dysfunction. Neurochem Res. 2024 Nov 16;50(1):10. doi: 10.1007/s11064-024-04272-z. PMID 39548030
• Results publication: Punch E, Klein J, Diaba-Nuhoho P, Morawietz H, Garelnabi M. Effects of PCSK9 Targeting: Alleviating Oxidation, Inflammation, and Atherosclerosis. J Am Heart Assoc. 2022 Feb;11(3):e023328. doi: 10.1161/JAHA.121.023328. Epub 2022 Jan 20. PMID 35048716
• Results publication: Gutierrez J, Turan TN, Hoh BL, Chimowitz MI. Intracranial atherosclerotic stenosis: risk factors, diagnosis, and treatment. Lancet Neurol. 2022 Apr;21(4):355-368. doi: 10.1016/S1474-4422(21)00376-8. Epub 2022 Feb 7. PMID 35143758
• Results publication: Park TH, Lee JK, Park MS, Park SS, Hong KS, Ryu WS, Kim DE, Park MS, Choi KH, Kim JT, Kang J, Kim BJ, Han MK, Lee J, Cha JK, Kim DH, Kim JG, Lee SJ, Cho YJ, Kwon JH, Shin DI, Yeo MJ, Sohn SI, Hong JH, Lee JS, Choi JC, Kim WJ, Lee BC, Yu KH, Oh MS, Park JM, Kang K, Lee KB, Lee J, Gorelick PB, Bae HJ. Neurologic deterioration in patients with acute ischemic stroke or transient ischemic attack. Neurology. 2020 Oct 20;95(16):e2178-e2191. doi: 10.1212/WNL.0000000000010603. Epub 2020 Aug 14. PMID 32817184
• Results publication: Glavan M, Liu J, Sampaio Silva G, Nguyen TN, Zhou J, Sestan N, Kimberly WT, Sheth KN. Endovascular thrombectomy for acute stroke: evolving eligibility criteria and adjunct therapies. Lancet Neurol. 2026 Jan;25(1):61-76. doi: 10.1016/S1474-4422(25)00356-4. PMID 41389830
• Results publication: 《中国卒中中心报告》编写组. 《中国卒中中心报告 2020》概要.中国脑血管病杂志. 2021;18(11):737-743.